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THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
THR cemented vs uncementd
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THR cemented vs uncementd

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  • 1. Primary Total Hip Replacement Cemented vs Un cemented
  • 2. Total Hip Replacement Types ( based on fixation technique ) • Cemented • Un cemented • Hybrid • Reverse hybrid
  • 3. Implant selection • Patients age • Underlying bone pathology • Type of medullary canal DORR classification
  • 4. Cemented stems • Elderly patients , particularly females • Inflammatory and metabolic bone disease • Cylindrical morphology of proximal femur ( DORR C )
  • 5. Cement less stems • Younger and relatively younger patients • AVN, osteoarthritis, Post traumatic arthritis • Funnel shaped proximal femur ( DORR A )
  • 6. Cemented stem designs • Taper slip • Composite beam
  • 7. Taper slip design • Collar less, tapered • Subsidence results in tighter wedging • Shear converted into compressive stresses
  • 8. Composite beam design • Collared • Rough surface • Co-Chrome (stiff ) stem • Strain on cement mantle reduced
  • 9. Cementing technique • Broach only technique • Antibiotic cement • Third generation cementing • Uniform cement mantle 2 to 3 mm thick
  • 10. Cement less ( Press fit ) designs • Tapered • Cylindrical • Anatomic
  • 11. Tapered stem design First generation • Load femur proximally only • Proximally coated • Tapered AP and ML • No collar Second generation • Rotational ridges and polished tip
  • 12. Cylindrical stem design First generation • Cylindrical distally and distal press fit • Extensively porous coated • Usually collared Second generation • Better proximal fit • Distal flutes and coronal slots • Polished tip
  • 13. Anatomic stem design First generation • Better proximal fill and fit • Anteverted necks ( right and left ) • Significant thigh pain and osteolysis Second generation • Bowed tip eliminated • Flattened posterior and lateral sides
  • 14. Types of porous coating Secondary stability • Sintering • Diffusion bonding • Plasma spraying Optimal pore size 100 to 400 µm
  • 15. Interphase dynamics • Gap should be < 0.5 mm • Micro motion should be < 50 µm
  • 16. Ceramic coating • Hydroxyapatite • Tri calcium phosphate • Fills Bone Implant gaps • Bioactive and bio-absorbable • Particulate disease • Heterotopic bone
  • 17. Cemented acetabular component All poly cup • Hypotensive anaesthesia • Good cancellous bed • Proper cement pressurization
  • 18. Cement less acetabular component • Hemispheric cups with porous coating • Fixation with press fit or screws
  • 19. Cement less acetabular component • Screw holes eliminated or reduced • Polished inner surface • Improved socket liner conformity and locking
  • 20. Out comes • Medium and long time Survival rates are good for both types of femoral components • Pelvic osteolysis is still a problem with both types of cups • Loosening is a problem with cemented acetabular components after the first decade
  • 21. Technique and time Cemented THR is technically more demanding • Blood less field • Cement pressurization • Uniform and homogenous cement mantle
  • 22. Post op. weight bearing Cemented immediate Un cemented 4 to 6 weeks immediate if fill and fit is good
  • 23. Peri-prosthetic fractures • More common with un cemented • More on the femoral side and in elderly females • Intra op. fractures 0.3 % ( cemented ) 5.4 % ( un cemented ) ( Mayo clinic registry )
  • 24. Deep infections No difference between the types- when Cemented THR is done with antibiotic impregnated cement
  • 25. Dislocations More common with un cemented due to imperfect version and soft tissue balancing
  • 26. Cost • Manufacturing cost of un cemented implants is more • With cemented THR - cement , related equipment, increased operating room time • Cost difference is $ 300
  • 27. Recent Trends Swedish Hip Registry 2008 Australian Jt Registry 2009
  • 28. Summary Cemented or un cemented Elderly patients , particularly females with poor bone quality ----- cemented hip. Otherwise ------ un cemented hip
  • 29. Summary Un cemented hips Implants Femur Tapered, proximally coated Acetabulum Hemispheric cup without holes
  • 30. Summary Un cemented hips • Appropriate implant size • Careful insertion • Primary implant stability with press fit For adequate osseous integration • Literature does not support routine usage of ceramic coated implants
  • 31. Summary Cemented hips Implants Femur tapered, collar less, smooth surface Acetabulum Highly cross linked all poly
  • 32. Summary Cemented hips • Blood less cancellous acetabular bed • Cement pressurization • Third generation cementing technique • Uniform, homogenous cement mantle • Be ware of embolic manifestations in cardio- pulmonary compromised patients
  • 33. Thank you

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